Regional nodes what. Breast lymphadenopathy: signs, symptoms and treatment methods

Head and neck	homolateral parotid, submandibular, cervical and supraclavicular lymph nodes
Rib cage	homolateral axillary lymph nodes;
Upperlimb	homolateral lymph nodes in the cubital fossa and axillary lymph nodes;
Abdominal wall, lower back and buttocks	homolateral inguinal lymph nodes;
Lowerlimb	homolateral lymph nodes in the knee fossa and inguinal lymph nodes;
Anal ring and skin around the anus	homolateral inguinal lymph nodes.

NX-Insufficient data to assess the status of regional lymph nodes

N0 -No signs of damage to regional lymph nodes

N1 - There are metastases in regional lymph nodes

M- Distant metastases

MX-Insufficient data to determine distant metastases

M0 - Distant metastases are not detected

M1-There are distant metastases

pTNMPathomorphological classification

pN0 Material for histological examination after regional lymphadenectomy must include at least 6 lymph nodes.

table 2

Grouping by stage

Stage 0
StageI
StageII
StageIII	AnyT
StageIV	AnyT	AnyN	M1

Histological variants of skin cancer

There are several histological types of skin cancer: basal cell, squamous cell and metatypical, which combines the features of the first two options. Skin adenocarcinoma also occurs, developing from skin appendages - sebaceous and sweat glands, hair follicles, as well as Merkel cell cancer.

Basal cell carcinoma

Basal cell carcinoma is a tumor consisting of cells that resemble cells in the basal layer of the epidermis. This is the most common malignant skin tumor. The tumor has invasive, infiltrative, locally destructive growth. It may recur after treatment, but almost never metastasizes.

The tumor is predominantly localized on the skin of the face (nose, temporal region, cheeks, periorbital region) and neck, and somewhat less frequently on the skin of the torso. Basal cell carcinoma can develop from various morphological structures, such as the epidermis and hair follicles, resulting in different forms of the disease. Among the latter, nodular, superficial, ulcerative and cicatricial forms are distinguished.

As a rule, the tumor is a hemispherical formation with a smooth surface, pink-pearl color, and dense consistency. At the top of the node, small dilated blood vessels are visible. The skin pattern at the site of the lesion smooths out or completely disappears. The node slowly increases in size, reaching 5-10 mm. Over time, ulceration appears in the center. The edges of such an ulcer are raised, thickened like a roller, pink-pearl-colored, with telangiectasias. The bottom of the ulcer is covered with a gray-black crust, greasy, lumpy, red-brown in color. Primary multiple basal cell carcinomas are also found.

Squamous cell carcinoma

Squamous cell skin cancer is a malignant tumor of cells similar to the cells of the squamous layer of the epidermis, both in appearance and in the molecular structure of the keratin they produce.

The tumor occurs more often in men over 50 years of age and is more common in southern latitudes. Mostly exposed areas of the skin are affected, as well as areas of the skin that are subject to constant trauma and the zone of transition of the skin to the mucous membrane (lips, nose, anogenital area). Clinically, this type of cancer is different from basal cell carcinoma.

Clinically, the tumor initially manifests itself as a small tumor-like formation with a smooth or bumpy surface, which quickly grows and ulcerates. The ulcer, as a rule, is characterized by sharply raised, dense edges surrounding it on all sides in the form of a cushion. The bottom of the ulcer is uneven. The ulcer itself looks like a crater. An abundant serous-bloody exudate is released from the ulcerative defect, hardening in the form of crusts. A cancerous ulcer progressively increases in size, both in width and depth.

The tumor is characterized by regional metastasis. In this case, depending on the location, dense, painless, mobile lymph nodes appear in the groin, axillary areas or on the neck. Later, the nodes grow, they adhere to the surrounding tissues, to the skin and disintegrate with the formation of ulcerated infiltrates.

Adenocarcinoma from skin appendages is quite rare. end of form beginning of form The course of this form of cancer is more rapid and has a tendency to recur and metastasize to regional lymph nodes. The skin of the eyelids and ears is most often affected. Initially, as a rule, a hard nodule appears, which subsequently ulcerates, forming a crater-shaped ulcer of various sizes. It can also be localized on other areas of the skin.

Merkel cell cancer, is an aggressive malignant tumor. Merkel cells are located next to the basal cell layer of the epidermis and are thought to be responsible for the function of touch. It is also known as trabecular cell carcinoma, Toker's tumor, and primary neuroendocrine carcinoma of the skin. Some scientists prefer the term "primary neuroendocrine carcinoma of the skin" because it has not yet been proven that the tumor is of Merkel cell origin. Other areas may also be affected, including the limbs and torso. end of form beginning of form In 50-75% of patients, as the disease develops, metastases appear in the lymph nodes after some time. In most cases, the tumor affects older people over 65 years of age.

Diagnosis of skin cancer

The diagnosis of a malignant neoplasm of the skin is made on the basis of examination, medical history, objective data and additional examination methods.

Despite the emergence of a large number of instrumental examination methods, the clinical method still plays the main role in diagnosing skin cancer. Not only the affected skin area should be examined, but also the rest of the skin, as well as areas of possible regional metastasis. The diagnosis is confirmed by cytological examination of the material (scraping, smear-imprint from the tumor, or fine-needle puncture), or histological examination (biopsy).

Skin cancer treatment

The choice of treatment method depends on the histological structure of the tumor, stage, clinical form and location of the tumor.

Surgical treatment is an independent method for basal cell carcinoma, as well as for squamous cell carcinoma without regional metastases, and for tumor relapses. Moreover, in the case of basal cell carcinoma, during excision, it is enough to retreat 0.5-1.0 cm from the edge of the tumor, and in the case of squamous cell carcinoma - 2-3 cm. For small defects, they are closed with local tissues, and for large ones, using one of the plastic methods closing. In the presence of regional metastases, lymph node dissection is performed in the appropriate area in combination with radiation therapy.

Radiation treatment, given the high radiosensitivity of skin cancer, can be an independent method for basal cell carcinoma, as well as for squamous cell carcinoma in the case of small tumors. In this case, close-focus X-ray therapy is used. For large and infiltrative tumors, combined radiation treatment is used, in which external beam radiation therapy is used first, and then close-focus radiotherapy. For regional metastasis, external beam radiation therapy is used to the area of regional lymphatic drainage as a stage of combined treatment.

Chemotherapy as a local treatment (omainic, prospidinic, 5-fluorouracil ointments) can be used in the treatment of small tumors and relapses of basal cell carcinomas. Systemic chemotherapy is used for palliative treatment in patients with a generalized form of the disease.

Laser therapy and cryodestruction are effective for small tumors and are used when tumors are located near bone and cartilaginous tissues.

For facial skin cancer localized near the so-called critical organs (lens, nasal cartilage), when difficulties arise during radiation therapy, and surgical treatment is difficult due to the lack of local tissue for plastic surgery, photodynamic therapy gives good results.

Thus, for stages I-II of the disease, as a rule, one of the treatment methods is used (surgical, radiation). In stage III, combination treatment is mainly used. At stage IV, palliative action on the tumor is possible (excision for sanitary purposes, radiation therapy)

Preventing skin cancer

Measures to prevent skin cancer are:

Protection of the face and neck from intense and prolonged sun exposure, especially in older people with light skin that is difficult to tan;

Regular use of nourishing creams to prevent dry skin;

Radical treatment of long-term non-healing ulcers and fistulas;

Protection of scars from mechanical injuries;

Strict adherence to personal hygiene measures when working with lubricants and other aggressive substances containing carcinogens;

Timely treatment of precancerous skin diseases.

Skin melanoma

In modern and earlier literature, there is a very wide range of opinions regarding the connection between the development of melanoma and pigmented nevi and other skin lesions. According to materials from various authors, melanoma occurs against the background of these diseases, in particular pigmented nevi, within 10-100% of cases. In the vast majority of cases (approximately 70% of patients), melanoma develops at the site of congenital or acquired skin lesions, and only in 28-30% - on unchanged skin. Pigmented and pigmented formations on the skin occur in 90% of the population, and their number ranges from single formations to several dozen. Consequently, a practicing oncologist, dermatologist, as well as doctors of other specialties, very often encounter a variety of pigmented skin lesions, and among them, melanoma accounts for 0.5-3% of cases. The results of clinical and morphological comparisons were analyzed in patients who sought surgical help for pigmented and pigmented formations for cosmetic reasons, fears of malignancy, or for objective indications (macroscopic changes in the formation). It turned out that 71.1% of such patients are treated on an outpatient basis and only 28.9% are admitted to inpatient treatment. It should be emphasized that 4.7% of these outpatients were individuals with initial signs of malignant growth of pigmented nevi.

There are many classifications of nevi. In our opinion, the most practical classification proposed by N.N. Trapeznikov et al., since it is based on a clear consideration of the danger of developing melanoma from the previously mentioned diseases and predetermines the appropriate treatment tactics, being a good guideline for the doctor. According to this classification, two main groups of diseases are distinguished: a) melanoma-dangerous nevi and some non-neevoid skin formations and b) melanoma-dangerous nevi and skin lesions.

To the group melanoma-neuvoid nevi and non-nevoids formations include intradermal pigmented nevus (common birthmark), fibroepithelial nevus, papillomatous and verrucous (including hairline) nevi, “Mongolian” spot, halonevus (Setton’s nevus) and some other skin diseases (for example, seborrheic keratoma, hemangioma, telangiectatic granuloma , lenticular dermatofibroma, histiocytoma).

For orientation, let us present a brief description of some of these formations.

Intradermal nevus. This is an ordinary birthmark, as a rule, found in almost all people, and their number varies - from a few to several dozen. A distinctive feature of these nevi is persistent hyperpigmentation, clear boundaries, soft consistency similar to palpation of the surrounding skin, absence of inflammatory phenomena, inflammation on the surface. They should be distinguished from the so-called hyperpigmented spots during pregnancy, freckles, lentigines, etc.

Fibroepithelial nevus. It can exist from birth or appear at different periods of life. It is most often localized on the face or torso. These nevi can be single or multiple. The formation has the shape of a hemisphere, a wide base, rises above the level of the skin, and is occasionally located on a stalk. The consistency of nevi is soft or soft-elastic, the size is a few millimeters, a centimeter or a little more. The color of the tumor varies from the tone of the surrounding skin to dark brown. In most cases, the hair growth is preserved or even increased (fibroepithelial pilaris nevus). If there is telangiectasia on the surface of the formation, the nevus is called angiofibroepithelial. The nevus can become inflamed, for example, during injury, then an infiltrate appears around it, sometimes with fluctuation, resembling a suppurating atheroma.

Papillomatous and verrucous nevi . In most cases, these essentially clinically identical types of nevi exist from birth or early childhood and usually grow slowly. They are found on any part of the body, although papillomatous nevi are more often localized on the scalp, and verrucous nevi on the skin of the trunk and limbs. These formations have a bumpy surface, protrude significantly above the surface of the skin, there is usually hair on their surface, and cracks are sometimes visible on verrucous nevi. The color of nevi ranges from the color of normal skin to black. The sizes of the described formations can be very different, up to 6 - 7 cm. Papillomatous and even more so pigmented hairy verrucous nevus, especially located on the face and other open areas of the skin, causes patients, especially women, significant cosmetic inconvenience and patients often insist on eliminating such nevi. Correct diagnosis and choice of adequate treatment tactics in such cases are very responsible for the doctor. It seems to us that consultation with an oncologist in such situations is mandatory.

"Mongolian" spot. The clinical picture of this disease is unique. The “Mongolian” spot is almost always located in the lumbosacral region, but can also be localized in other areas of the skin. Its lesion is round in shape, with clearly defined boundaries, bluish, cyanotic or brown in color. The spot can reach 5-6 cm in diameter. As a rule, the “Mongolian” spot is a congenital formation; it gradually decreases in size, changes color and in most cases disappears in childhood.

Halonevus, or Setton's disease (from the Greek word “halos” - ring, circle). It is a formation that slightly rises above the level of the skin, elastic consistency, reddish-brown color, 2-5 mm in diameter, with a characteristic feature - the presence of a depigmented rim in the circumference. This corolla is several times larger than the pigmented formation located in the center. According to some researchers, halonevus are often combined with other non-nevoid skin formations, for example, fibroepithelial nevi. May occur with cancer of internal organs.

Melanoma-dangerous nevi and skin lesions

This group mainly includes the following diseases: borderline pigmented nevus, blue nevus, nevus of Ota, giant pigmented nevus and limited precancerous melanosis of Dubreuil.

There is evidence that melanoma-dangerous nevi are much less common than non-melanoma-dangerous formations. With all the validity of this statement, it should be borne in mind that in the practice of an oncologist, melanoma-dangerous nevi and skin lesions should cause special concern due to the high potential for their transformation into melanoma, especially since the treatment tactics for them have significant differences.

Here is a brief description of the diseases in the group under consideration.

Borderline pigmented nevus. Usually has the form of a flat nodule ranging in size from several millimeters to several centimeters (4 - 5 cm), but most often the diameter of the nodule is 1 cm. The localization of this formation may be different, but it should be borne in mind that, according to some researchers , pigmented nevi located on the skin of the palms, soles, and genitals, as a rule, are borderline. The surface of the nevus is dry, smooth, occasionally uneven, and always devoid of hair. The consistency of the formation in most cases does not differ from the surrounding skin, but may be denser. The color of the border nevus varies - from light brown, bluish-violet to black. Sometimes the contours of the formation or spot have a wavy shape. The formation may change in size and color, but very slowly. They also describe the so-called cockade border nevus, which is characterized by gradually increasing pigmentation along the periphery in the form of concentric rings. It should be noted that a borderline pigmented nevus can be single, but multiple formations are also possible.

Blue nevus. It is a hemispherical formation protruding above the skin level, with a clear boundary. The surface of the nevus is soft, without hair, and has the appearance of tightly stretched skin. Its color is blue or dark blue, less often brown. The size of the nevus is small and, as a rule, does not exceed 1 cm in diameter. It should be noted that the blue nevus is most often found on the face, foot, sole, buttocks, and lower legs. Usually the formation is single, but cases of numerous blue nevi have been described.

Nevus of Ota. Some authors call it a black-bluish oculomaxillary nevus. The typical localization of this formation is the face (the area of innervation of the 1st and 2nd branches of the trigeminal nerve). It consists of one large or many black-bluish spots merging with each other, located in the area of the cheek, upper jaw, and zygomatic arch. In this case, pigmentation is required in various parts of the eye: conjunctiva, sclera, iris. Sometimes the process involves the red border of the lips and the mucous membranes of the nose, soft palate, pharynx, and larynx.

Giant hair pigment nevus . This congenital nevus is rarely found on the face and usually affects the extremities and trunk. The nevus increases in size relatively quickly as the child grows. It reaches a size from 10 to 40 cm or more. Its surface is uneven, warty, with cracks. Hypertrichosis is often observed. The color of the formation is from gray to black. It must be said that, according to various authors, the transformation of this nevus into melanoma is a frequent phenomenon - according to the collected statistical data of some researchers, malignancy of a giant pigmented nevus occurs in 1.8 - 13% of patients. It should be recalled that, according to some authors, malignancy of giant pigmented nevi in children is especially dangerous. Without dwelling on this disease in detail, we note that a giant hairy pigmented nevus should always raise suspicion regarding its transformation into melanoma. It is also worth mentioning the opinion of some researchers who point to the fact that in certain cases a giant nevus is accompanied by other congenital malformations, such as hydrocephalus, neurological disorders and the occurrence of primary melanoma of the pia mater, which is very important in diagnostic terms.

Dubreuil's limited precancerous melanosis (synonyms: lentigomaligna, melanoma in situ, melanosis maligna, melanoma praecancerosa, lentigomelanoma, melanocytoma, nevocytoma, etc.). Some researchers classify Dubrey's melanosis as pigmented nevi, in particular melanoma-dangerous ones, while others argue that Dubrey's limited precancerous melanosis is not a nevus or nevoid formation, but belongs to dermatoses. Dubreuil's melanosis, of course, belongs to melanoma-dangerous formations. Moreover, we share the opinion of those few researchers who believe that melanoma developing at the site of Dubreuil’s melanosis may have a more malignant course than non-genic melanoma. Therefore, the treatment tactics for this disease, which will be discussed below, should be more active than for the so-called melanoma-dangerous nevi.

The clinical picture of Dubreuil's melanosis is quite characteristic. Mostly elderly people are affected. The disease usually begins with a small pigment spot. Further, the focus, developing, acquires blurred boundaries. In a developed state, Dubreuil's melanosis ranges from 2 - 3 to 5 -6 cm in diameter.

Epidemiology, risk factors, pathogenesis of skin melanomas

It is generally accepted that in recent years there has been a significant increase in the incidence of skin melanoma in different countries and continents of the world. It varies from 5 to 30 or more per 100,000 population per year, and its frequency is 1-4% of all malignant tumors. According to some authors, the incidence and mortality from skin melanoma in a number of countries is growing much faster than from malignant tumors of other locations, excluding lung cancer. The largest number of registered patients diagnosed with melanoma for the first time in their lives was noted in Australia - 40 new cases per 100,000 population per year. In the United States, 32,000 patients with newly diagnosed melanoma are identified annually, and in the states of New Mexico and Arizona the incidence rate has quadrupled. In the CIS countries, the number of patients diagnosed with melanoma for the first time in their lives is close to 10,000 per year. In general, the annual incidence of melanoma increases in different countries by 2.6-11.7%. Most researchers are convinced that the incidence is constantly doubling over every ten-year period. In 1967, W.H. Clarc introduced into routine microscopic diagnosis of skin melanoma the determination of the level of tumor invasion into the underlying layers of the dermis. For the first time, a microstaging technique for local skin melanoma was proposed, which correlated well with the possible prognosis of the disease and was based on the anatomical structure of the skin. Previously, the stage for local melanoma of the skin was set based on the value of the maximum diameter of the tumor. Such an attempt to assess the prognosis of the primary tumor was essentially doomed to failure, since, firstly, cutaneous melanoma is not characterized by large linear dimensions with a maximum diameter exceeding 2 cm. Secondly, horizontal microscopic spread correlates only slightly with microscopic growth of invasion. The author of the method proposed to distinguish 5 levels of skin melanoma invasion in the dermis. Level 1 - melanoma cells are located within the epidermis and the nature of the invasion corresponds to melanoma in situ. Level 2 - the tumor destroys the basement membrane and invades the upper parts of the papillary dermis. Level 3 - melanoma cells fill the entire papillary layer of the dermis, but do not penetrate into the underlying reticular layer. Level 4 of invasion - invasion of the reticular layer of the dermis. Level 5 - invasion of the underlying fatty tissue. In 1970, A. Breslow proposed another method for establishing the microstage of primary skin melanoma. Its essence was to measure the thickness of the tumor or its maximum vertical size in millimeters. The predominant localization of melanomas in women is the lower extremities (lower leg), in men - the torso (usually the back); in both sexes in the older age group (65 years and older), melanoma is localized mainly on the skin of the face. According to world statistics, the vast majority of patients with skin melanoma are adults, whose average age is 40-50 years. In most of Europe, women are more likely to get sick, but in Australia and the USA the incidence of women and men is equal.

There are a number of factors, or risk phases, that play a significant role in the pathogenesis of cutaneous melanoma. They can be exogenous or endogenous.

One of these carcinogenic factors is solar radiation (ultraviolet rays), especially for persons with congenital or acquired nevi, Dubreuil's melanosis or other neoplasms and skin lesions. Other physical factors of pathogenesis include ionizing radiation, chronic irritation, burns, frostbite, chemical, temperature or mechanical trauma to nevi, including self-medication and non-radical cosmetic interventions.

According to a number of researchers, in the etiology and pathogenesis of melanomas, in addition to external factors, genetic factors of an ethnic order, endogenous constitutional features and the nature of pigmentation, such as the color of the skin, hair and eyes, changes in hair color, the presence of freckles on the face and hands, are also of significant importance , number, size and shape of moles on different parts of the body, skin reaction to ultraviolet rays. Thus, melanoma is more common and has a worse prognosis in blondes and redheads. According to American researchers, melanoma is rare in the black population. When it occurs in this population, it usually affects the skin of the fingers and toes or palms and soles. Studying the incidence of melanoma in white Americans, it was found that 11% of Americans are red-haired, and among melanoma patients they make up a clear majority - 65%. There are isolated reports about the viral nature of melanomas.

The state of endocrine function is essential in the pathogenesis of melanomas. Puberty, pregnancy, and menopausal changes in the body are critical periods that are regarded as risk phases for the activation and malignancy of pigmented nevi. Melanoma is not observed in men or women castrated for any reason.

Among risk factors, family history should be given serious attention. Many members of some families have dysplastic nevi. These individuals are at very high risk for melanoma and should be screened at least every 3 to 6 months. This group also includes people who have previously had melanoma, as well as their relatives. Taking into account risk factors plays a significant role in the early diagnosis of melanoma, which, of course, has a beneficial effect on treatment results.

The pathological picture of melanomas is very diverse. There are main forms of melanoma growth:

Superficial spreading. It occurs, according to most authors, equally often in people of both sexes, although some researchers insist that women are predominantly affected. This form accounts for the frequency of 39-75% of all skin melanomas. The most common location of the tumor is the skin of the back. In men, this form of melanoma is observed twice as often on the skin of the head, neck, back, chest, abdomen, and in women - three times more often on the skin of the thighs and legs. It has 2 phases of development: horizontal or radial (spread along the plane of the skin, within the epithelial layer, with thickening of the epidermis by 2-4 times due to the accumulation of melanocytes) and subsequent vertical, characterized by invasion through the basement membrane into the reticular layer of the dermis and subcutaneous fatty tissue . Clinically, this tumor is, as a rule, a slowly growing, up to five years old, pigment spot with clear contours, flat or raised above the skin level, of dense consistency. Subsequently, rapidly growing dark nodules or white and bluish areas may appear on such a spot. According to some reports, the mortality rate for this form of melanoma can reach 31%.

Nodal form. It occurs in 15-30% of cases of skin melanomas, mainly in middle-aged people on the skin of the back, head, and neck. More often observed in men. It has only one growth phase - vertical. Invasion occurs in the dermis, through all its layers, and into the underlying subcutaneous fatty tissue. Clinically, this form of melanoma has the form of a node, exophyte, polypanic stalk, dark blue or black in color, bleeding, often ulcerating. The edges of the tumor are distinct or uneven. The mortality rate for this form, according to some data, reaches 56%.

Malignant lentigomelanoma. Accounts for 10-13% of all melanomas. Develops at the site of obligate pre-melanoma skin lesions. The predominant localization is the scalp, neck, and back of the extremities. More common in women. The age of patients is about 70 years and older. The tumor goes through two phases of development - radial, the duration of which can reach 10.20 or more years, and vertical, during which invasion into the dermis occurs. During invasion, tumor cells acquire an elongated, spindle-shaped shape. Clinically, lentigomelanoma appears as a flat spot without clear boundaries, loose consistency, brown, dark brown or black. As a rule, it has a slow growth rate, but in the vertical growth phase, rapidly growing tumor nodes are formed on the surface, and melanoma metastasizes quickly. The mortality rate for lentigomelanoma reaches 10%.

Acral lentigenous melanoma. Makes up about 8% of all melanomas. It occurs on the plantar surface of the foot, palmar surface of the hand or in the subungual bed, mainly in people with dark skin (Negroid, Asians, etc.), usually aged 60 years and older. The neoplasm develops quite quickly (on average within 2.5 years), increasing in width, acquiring a reddish-brown or brown color, irregular outline and resembling lentigomelanoma. In contrast to the latter, acral lentigenous melanoma is more prone to metastasis. The tumor often ulcerates, and when neglected, mushroom-like growths appear on it.

Melanomaskin - classificationTNM: T - primary tumor, N - regional lymph nodes, M - distant metastases. Their definition is the same as for skin cancer (Table 3).

The lymphatic system is a network of lymphatic vessels that transport lymph. Lymph nodes are an important part of this system. They are distributed unevenly throughout the body. The human body contains about 700 lymph nodes.

Lymph is a colorless liquid in the human body that washes all tissues and cells of the body.

Lymph is collected in many small lymphatic vessels that converge in the lymphatic trunk. On its way to the heart, lymph passes through various lymph nodes. Each of them is responsible for absorbing and filtering lymph in a specific area of the body. The most important regions where lymph nodes are located are the neck, jaw, armpit, groin, abdomen and chest.

In the International Classification of Diseases, 10th revision (ICD-10), inflammation of regional lymph nodes is designated by code L04.

Anatomy and physiology

Lymphatic fluid from the head and neck collects in two places: the right and left jugular trunks. From the right lymphatic vessel, lymph enters the right lymphatic duct, and from the left - into the thoracic duct. Before entering the ducts, it passes through the regional lymph nodes:

Mastoid.
Occipital.
Parotid.
Submandibular.
Facial.

Lymph nodes eliminate bacterial, viral and cancer cells. They contain a large number of B-, T- and NK-lymphocytes.

Regional lymph nodes play an important role in protecting the body from disease. They perform different tasks. The central function is the removal of intercellular fluid from the body, the peripheral function is the filtration of lymph. Smaller lymph nodes receive lymph from surrounding tissues and pass it on to larger ones. If the lymph contains degenerated cells (cancer cells), the lymph nodes release molecules that initiate cell death.

It is important to keep the lymph fluid moving and filtering constantly. Otherwise, it may stagnate. If lymph doesn't move enough, lymphedema can occur. After filtration, the purified lymph is returned to the tissue and the process begins again.

Normal size of lymph nodes

The size of the lymph nodes depends on the person’s health status and previous immunological diseases. The normal size of lymph nodes varies from 2 mm to 2 cm. If an infectious or cancerous disease occurs, they can increase significantly. When the lymph nodes become inflamed, they produce more protective cells to fight pathogens. If the lymph nodes are larger than 2 cm and take a spherical shape, then they are in an activated state.

Reason to visit the doctor

If your lymph nodes are swollen and your body temperature rises, you should make an appointment with your doctor.

If you develop fever (above 38.5 degrees Celsius), sudden weight loss or night sweats, you should immediately consult a doctor as the symptoms indicate malignant lymphoma. Lymph nodes also enlarge in response to bacterial or viral infection.

Enlarged lymph nodes

The reasons for enlarged lymph nodes can vary significantly, but the common feature is increased activity of the immune system. Lymph nodes play a critical role in the immune response as they are the central filtering organs.

The main reasons for enlarged regional lymph nodes:

Malaria.
Metabolic diseases (Gaucher disease).
Systemic infectious diseases - influenza, measles, rubella and mumps.
Kawasaki syndrome (mainly in children).
Necrotizing lymphadenitis.
Lyme disease.
Thyroid diseases.
Surgical interventions.
Injuries and wounds.
Cat scratch disease.
Brucellosis.
Tuberculosis.
Hodgkin's lymphoma.
Acute lymphocytic leukemia.
Chronic lymphocytic leukemia.
Acute myeloid leukemia.
Intolerance to certain medications.

All pathogens that enter the body are filtered in the lymph nodes. Germs are transported through the lymphatic system and remain in the lymph nodes. There, cell growth and division are stimulated. As a result, an enlargement of the lymph nodes is observed, which disappears after the pathogen is eliminated.

With cancer, which can affect the entire body, lymph nodes become enlarged throughout the body. Cancer cells of a malignant tumor enter the tissue fluid and are filtered out by the lymph nodes. Sometimes they remain in them, multiply and spread to other organs. The result of this is so-called metastases to other lymph nodes.

There are two forms of lymphoma: Hodgkin and. Hodgkin's disease is characterized by the presence of giant cells that grow from B lymphocytes. If one or more lymph nodes are involved in cancer, this indicates an advanced stage of malignant lymphoma.

Pain

Pain in the lymph nodes is a favorable sign that indicates the presence of an infectious disease. With lymphoma, the lymph nodes are painless in most cases. If additional complications occur, pain may also occur. The most common disease characterized by pain is the common cold.

Interesting! A nonspecific symptom of Hodgkin lymphoma, which does not appear in all patients, is pain in the lymph nodes after drinking large amounts of alcohol. As a rule, pain appears the next day after drinking alcoholic products.

Classification

Acute lymphadenitis is accompanied by pain in the area of the cervical lymph nodes

Regional lymph nodes are classified by location:

Inguinal: legs, abdominal wall, buttocks.
Axillary: arms.
Cervical: head, face, neck.
Mediastinal: breast (breast).
Para-aortic: abdominal organs.

According to the clinical course, lymphadenitis is distinguished between acute (up to 4 days) and chronic (4-6 days). Acute inflammation of the upper respiratory tract is usually often accompanied by inflammatory swelling of the cervical lymph nodes. Chronic inflammation of the upper respiratory tract can also cause its enlargement. Inflammation in other organs is less often manifested by enlarged lymph nodes.

Lymphoma is staged according to the Ann Arbor classification. There are 4 stages, which are characterized by varying involvement of lymph nodes and organs outside the system in the malignant process. There are also asymptomatic and symptomatic forms of lymphoma.

Diagnosis of inflammation of the lymph nodes

Physician skill and the accuracy and reliability of diagnostic procedures can sometimes affect patient survival. Although lymph nodes may become enlarged with cancer, patients still feel healthy. Many syndromes associated with swollen lymph nodes do not always present with severe local inflammation. Numerous diseases develop slowly.

First, a history is taken and a physical examination is performed. After a medical examination of the lymph nodes, doctors can already draw the first conclusions about the existing disease.

During a physical examination, the doctor takes into account the following characteristics of the lymph nodes:

Soreness.
Consistency.
Size.
Portability.

Benign neoplasms move well, have a soft consistency and are painful. Malignant lymphomas have a hard consistency, are painless and adhere to the surrounding tissues, which is why they do not move well.

A lymph node filled with pus is easily recognizable because the fluid moves back and forth in a wave-like pattern under pressure. This phenomenon is called fluctuation. For purulent lymphadenitis, a blood test is performed. If the analysis reveals an increased concentration of inflammatory cells, this confirms acute lymphadenitis. The pattern of elevated inflammatory cells indicates the nature of the pathogens. If it is a bacterial infection, a certain type of white blood cell - called neutrophil granulocytes - increases significantly in the blood.

The patient's medical history is critical to the physical examination. In addition to palpation and auscultation, other vital signs such as blood pressure, heart rate and body temperature are also measured. The doctor also evaluates the condition of the skin, mucous membranes and other organs.

If a malignancy is suspected, the affected lymphoid tissue is removed and sent for histological examination to a pathologist. If the diagnosis is confirmed, further examinations are carried out to clarify the picture of the disease.

Additional diagnostic methods:

Ultrasonography.
General blood analysis.
Magnetic resonance imaging.
Scintigraphy.
CT scan.

How to treat lymph nodes?

Inflammation of the lymph nodes is treated with antiviral drugs and antibiotics

If the underlying infection or inflammation goes away, the swollen lymph nodes also return to their original size. Sometimes bacterial infections require antibiotic treatment. Patients are advised to administer the antibiotic not in tablet form, but through IVs directly into the blood so that it can safely reach the site of action. Antibiotic therapy requires a hospital stay of several days. An inflamed lymph node is also prone to suppuration, and therefore surgical removal is often necessary to avoid various consequences.

Indications for the use of broad-spectrum antibiotics:

Anthrax.
Syphilis.
Pharyngitis.
Bacterial diseases of the upper respiratory tract

For viral lymphadenitis, special therapy is usually not required. Inflammation of the lymph nodes goes away on its own if the patient remains in bed and takes enough fluids and vitamins.

Indications for the use of antiviral drugs:

Chicken pox.
Hepatitis C, B and A.
Measles.
Polio.
Yellow fever.
Rhinovirus and adenovirus infection.

The exception is glandular fever: in order to recover, doctors advise getting more rest, avoiding physical activity and, if necessary, using symptomatic medications - antipyretics, anti-inflammatory and painkillers.

If the enlarged lymph nodes are caused by cancer, chemotherapy or radiation therapy is prescribed. Radiotherapy and chemotherapy are often combined. If chemotherapy or radiotherapy is ineffective, antibody therapy, cytokine therapy, or stem cell transplantation are prescribed.

Swollen lymph nodes can also be caused or at least aggravated by stress and mental pressure. Prolonged rest and relaxation can greatly contribute to the shrinkage of regional lymph nodes. Patients are recommended to engage in autogenic training or Jacobson relaxation.

Advice! If there is a very sharp and rapid increase in regional lymph nodes, it is recommended to call an ambulance. If painless enlargement of the lymph nodes appears, which can be easily felt, it is also recommended to visit a specialist to find out the nature of the symptom. Seeking medical help early helps prevent possible complications that a certain disease may cause. It is not recommended to delay a visit to a specialist.

Metastasis is the most important characteristic of any malignant tumor. This process is associated with the progression of the disease, which often ends in the death of the patient. When the lymphatic system is affected by carcinoma of another organ, the average person can designate this phenomenon as “cancer of the lymph nodes”; from a medical point of view, this is, that is, a secondary lesion.

Malignant tumor cells have a number of differences from healthy ones, including not only a local destructive effect in a tissue or organ, but also the ability to separate from each other and spread throughout the body. The loss of specific protein molecules that provide a strong connection between cells (adhesion molecules) leads to the separation of the malignant clone from the primary tumor and its penetration into the blood vessels.

Epithelial tumors, that is, metastasize predominantly by the lymphogenous route, through lymphatic vessels that carry lymph away from the organ. Sarcomas (connective tissue neoplasms) can also affect lymph nodes, although the predominant route of metastasis for them is hematogenous.

Along the path of lymph flow, nature provides “filters” that retain everything “extra” - microorganisms, antibodies, destroyed cellular fragments. Tumor cells also fall into such a filter, but they are not neutralized, and instead the malignant clone begins to actively divide, giving rise to a new tumor.

metastasis

Initially, signs of secondary tumor lesions are found in regional lymph nodes, that is, those that are closest to the organ affected by the tumor and which are the first to encounter lymph carrying carcinomatous elements. With further progression of the disease, metastases spread further, capturing more distant lymphatic groups. In some cases, lymph nodes located in another part of the body are affected, which indicates an advanced stage of the tumor and an extremely unfavorable prognosis.

Enlargement of lymph nodes in cancer is a consequence of the proliferation of tumor cells in them, which displace healthy tissue, filling the lymph node. Inevitably, lymphatic drainage becomes difficult.

According to the histological structure, metastases usually correspond to the primary tumor, but the degree of differentiation in some cases is lower, so secondary lymph node cancer grows faster and more aggressively. There are often cases when the primary tumor manifests itself only as metastases, and the search for their source does not always bring results. Such a defeat is referred to as cancer metastasis from an unknown source.

Having all the features of malignancy, cancer (metastasis) in the lymph node poisons the body with metabolic products, increases intoxication, and causes pain.

Any malignant tumor sooner or later begins to metastasize; when this happens depends on a number of factors:

Age – the older the patient, the earlier metastases appear;
Concomitant diseases in a chronic form, weakening the body's defenses, immunodeficiencies - contribute to more aggressive tumor growth and early metastasis;
Stage and degree of differentiation - large tumors that grow into the wall of the organ and damage blood vessels metastasize more actively; The lower the degree of cancer differentiation, the earlier and faster the metastases spread.

Not every tumor cell that enters a lymph node will divide and metastasize. With good immunity, this may not happen or will happen after a long period of time.

In the diagnosis, an indication of metastatic disease of the lymph nodes is indicated by the letter N: N0 – lymph nodes are not affected, N1-2 – metastases in regional (nearby) lymph nodes, N3 – distant metastasis, when lymph nodes are affected at a considerable distance from the primary tumor, which corresponds to severe, fourth stage of cancer.

Manifestations of lymphogenous metastasis

Symptoms of lymph node cancer depend on the stage of the disease. Usually the first sign is their increase. If superficial lymph nodes are affected, they can be palpated in the form of enlarged single nodules or conglomerates, which are not always painful.

Such metastases to the lymph nodes are easily determined in the axillary region in case of breast cancer, in the groin in case of tumors of the genital tract, in the neck in case of diseases of the larynx, oral cavity, above and below the collarbone in case of stomach cancer.

If the tumor affects an internal organ, and metastasis occurs in the lymph nodes lying deep in the body, then detecting their enlargement is not so easy. For example, enlarged lymph nodes of the mesentery with intestinal cancer, the porta hepatis with hepatocellular carcinoma, the lesser and greater curvature of the stomach with tumors of this organ are inaccessible to palpation, and additional examination methods come to the aid of the doctor - ultrasound, CT, MRI.

Large groups of metastatic lymph nodes inside the body may manifest symptoms of compression of the organs or vessels next to which they are located. With enlarged mediastinal lymph nodes, shortness of breath, heart rhythm disturbances and chest pain are possible; mesenteric enlarged lymphatic collectors contribute to pain and bloating, and indigestion.

When the portal vein is compressed, portal hypertension will occur - the liver and spleen will enlarge, and fluid will accumulate in the abdominal cavity (ascites). Signs of difficulty in the outflow of blood through the superior vena cava - swelling of the face, cyanosis - may indicate that the lymph nodes are affected by cancer.

Against the background of metastasis, the patient’s general condition also changes: weakness and weight loss increase, anemia progresses, fever becomes constant, and the emotional background is disturbed. These symptoms indicate increased intoxication, which is largely facilitated by the growth of cancer in the lymph nodes.

Lymphogenous metastasis in certain types of cancer

The most common types of cancer are carcinomas of the stomach, breast in women, lungs, and genital tract. These tumors tend to metastasize to the lymph nodes, and the routes of spread of cancer cells and the sequence of damage to the lymphatic system are quite well studied.

At the first metastases can be detected in the axillary lymph nodes already in the second stage of the disease, and in the fourth they are present in distant organs. Lymphogenic spread begins early and often the reason for searching for a tumor is not a palpable formation in the chest, but enlarged lymph nodes in the axillary region.

Breast cancer is manifested by damage to several groups of lymph nodes - axillary, peri-sternal, supraclavicular and subclavian. If carcinoma grows in the outer parts of the gland, then it is logical to expect cancer metastases in the lymph nodes armpit, damage to the internal segments leads to the entry of cancer cells into the lymph nodes along the sternum. Distant metastasis will be considered to be metastasis to the specified groups of lymph nodes on the side opposite to the tumor, as well as damage to the nodes of the mediastinum, abdominal cavity, and neck.

At groups of regional lymph nodes affected first and distant ones involved in advanced stages have been identified. Regional are considered paratracheal, bifurcation, peribronchial lymph nodes located near the bronchi and trachea, distant - supra- and subclavian, mediastinal, cervical.

In the lungs, lymphogenous spread of cancer occurs early and quickly, this is facilitated by a well-developed network of lymphatic vessels necessary for the proper functioning of the organ. Central cancer growing from large bronchi is especially prone to such dissemination.

At metastases in the lymph nodes may have a peculiar location. The nodes along the greater and lesser curvature and antrum are the first to be affected, then the cells reach the celiac lymph nodes (second stage); gastric cancer can be detected in the lymph nodes along the aorta and portal vein of the liver.

Peculiar types of lymphogenous metastases of stomach cancer are named after the researchers who described them or first encountered them. Virchow's metastasis affects the left supraclavicular lymph nodes, Schnitzler's - the tissue of the rectal region, Krukenberg's - the ovaries, Irish's - the lymph nodes of the armpit. These metastases indicate distant dissemination of the tumor and a severe stage of the disease, when radical treatment is impossible or no longer practical.

Lymph nodes in the neck are affected by tumors of the fundus, gums, palate, jaws, and salivary glands. The pathological process involves the submandibular, cervical, and occipital groups of lymph nodes. Distant metastasis to the cervical lymph nodes is possible with carcinomas of the breast, lungs, and stomach. For cancer located in the face or oral cavity, lymphatic spread occurs quickly, which is associated with excellent lymph supply to this area.

In addition to metastases, in the lymph nodes of the neck primary tumors can form - lymphogranulomatosis, which the average person would also call cervical lymph node cancer. In some cases, determining whether the primary tumor or metastasis has affected the nodes in the neck is only possible with additional examination, including a biopsy.

Lymph nodes in the neck tend to enlarge not only with metastases. Probably, each of us can find at least one enlarged nodule under the lower jaw or between the neck muscles, but this does not necessarily indicate cancer. There is no need to panic, although it won’t hurt to find the reason.

Cervical and submandibular lymph nodes collect lymph from the oral cavity, larynx, pharynx, jaws, which very often have inflammatory changes. All kinds of tonsillitis, stomatitis, caries are accompanied by chronic inflammation, so it is not surprising that the regional lymph nodes are enlarged. In addition, the area of the mouth and upper respiratory tract is constantly encountered with various microorganisms, which enter with the lymph flow and are neutralized in the lymph nodes. Such increased work can also lead to lymphadenopathy.

Diagnosis and treatment of metastases to lymph nodes

Diagnosis of metastases in the lymph nodes is based on their palpation, if possible. If there is a suspicion of damage to the axillary or cervical inguinal lymph nodes, the doctor will be able to palpate them along their entire length; in some cases, palpation of internal lymph nodes - celiac, mesenteric - is possible.

Ultrasound of neck vessels

To confirm metastatic lesions, additional examination methods are used:

Ultrasound– is especially informative when there is an increase in lymphatic collectors located inside the body - near the stomach, intestines, at the gates of the liver, and in the retroperitoneal space, in the chest cavity;
CT, MRI– allow you to determine the number, size and exact location of the changed lymph nodes;
Puncture and biopsy– the most informative methods that allow you to see cancer cells in a lymph node; with a biopsy, it becomes possible to guess the source, clarify the type and degree of differentiation of cancer.

lymph node biopsy

Molecular genetic studies are aimed at establishing the presence of certain receptors or proteins on cancer cells, which can most likely be used to determine the type of cancer. Such analyzes are especially indicated when detecting metastases from an unknown source, the search for which was unsuccessful.

Treatment of cancer metastases in the lymph nodes includes surgical removal, radiation and chemotherapy, which are prescribed individually according to the type and stage of the disease.

Surgical removal of the affected lymph nodes is performed simultaneously with excision of the tumor itself, while lymph node dissection is performed on the entire group of regional collectors into which cancer cells have entered or could have entered.

For many tumors, so-called “sentinel” lymph nodes are known, where metastasis occurs most early. These nodes are removed for histological examination, and the absence of cancer cells in them most likely indicates the absence of metastasis.

When manipulating the tumor itself and the lymph nodes, the surgeon acts extremely carefully, avoiding tissue compression, which can provoke dissemination of tumor cells. To prevent cancer cells from entering the vessels, they are ligated early.

For metastases it is almost always prescribed. The choice of drugs or their combination depends on the type of primary tumor and its sensitivity to specific drugs. For stomach cancer, 5-fluorouracil and doxorubicin are most effective; for breast tumors, cyclophosphamide and adriamycin are prescribed; non-small cell lung cancer is sensitive to etoposide, cisplatin, taxol.

chemotherapy

If the primary focus of the cancer tumor cannot be identified, cisplatin, paclitaxel, gemcitabine, and etoposide are prescribed. For poorly differentiated carcinomas affecting the lymph nodes, platinum drugs (cisplatin) are effective; for neuroendocrine tumors, cisplatin and etoposide are included in the treatment regimen.

The goal of chemotherapy for metastatic tumors is to inhibit the growth and further spread of the malignant process. It is prescribed before surgery (neoadjuvant chemotherapy) to prevent metastasis and destroy micrometastases in the lymph nodes and after surgery (adjuvant) to prevent further metastasis, the risk of which increases after surgery on the affected organ.

radiation therapy

It is more important for hematogenous metastases than lymphogenous ones, but for lymph nodes radiosurgery, or cyber-knife, when cancer in a lymph node is removed using a beam of radiation acting strictly on the affected tissue, can be effective. This method is justified for late single metastases that appear years after treatment, when repeated surgery can be avoided.

Metastasis to lymph nodes in cancer, regardless of the type of primary tumor, characterizes the progression of the disease, and the worse the prognosis, the more lymph collectors are involved in cancer growth. Metastases respond to treatment only in a fifth of patients, in whom the prognosis may be favorable; in the remaining 80%, treatment at the metastasis stage is aimed at relieving symptoms or prolonging life. With multiple lymphogenous metastases of low- and undifferentiated carcinomas, life expectancy is on average six months to a year; in the case of highly differentiated cancers, the prognosis is slightly better.

Video: removal of lymph nodes in the treatment of breast cancer

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

Lymph nodes are invaluable to the body. In the area of the mammary glands there are a large number of lymph nodes. They are the first to respond to breast diseases - their inflammation accompanies up to 70% of cases of the disease. And in 100% of cases, lymph nodes in the mammary gland in women react to cancer.

Lymph nodes and their functions

Lymph nodes are the most important peripheral organ of the lymphatic system and part of the immune system of the human body. They act as filters, because with their help the body protects itself from microorganisms entering the blood. In order to most effectively block the path of various viruses and bacteria, lymph nodes are located near large blood vessels and important internal organs.

Their functions are as follows:

protective - in these nodes the formation of cells of the immune system occurs - leukocytes, phagocytes, antibodies and a substance that promotes their reproduction;
drainage - that is, it acts as a kind of filter, cleansing the body from foreign bacteria with the help of lymphocytes and macrophages;
participation in metabolism - redistribute substances and liquid between lymph and blood and remove toxic substances from the intestines.

Lymphatic system of the mammary gland

A woman's breast is a rather unique organ from an anatomical point of view. Due to the peculiarities of its structure, for example, the presence of mobility, the lymphatic system here is also slightly different from the rest.

Depending on the location of the thoracic lymph nodes, they can be divided into several groups that regulate the outflow of lymph from different areas.

The main groups of lymph nodes include the paramammary system, intramammary lymph nodes of the mammary glands, axillary and regional lymph nodes:

The paramammary system is located on the pectoralis major muscle, providing connection between the axillary groups of lymph nodes and their ducts.
Axillary lymph nodes in the mammary glands are located throughout the chest area and communicate with each other using paramammary lymph nodes.
Intramammary accumulations play an equally important role. What is an intramammary lymph node of the mammary gland? They are the most numerous and provide the function of redistributing lymph throughout the body. Depending on their anatomical location, they can be divided into central, external and subscapular. The central lymph nodes perform the main functions of draining lymph from the upper parts of the chest into the general flow.
The regional system includes the axillary and internal group of lymph nodes in the chest, which are located in the area of the pectoralis minor muscle. The internal group, which is located very close to the body, is the first to respond to the development of oncological processes.

Kinds

The main types of lymph nodes of the mammary gland can be divided into regional and axillary.

Regional

The entire lymphatic system is represented by a network of vessels along which there are clusters of nodes called regional ones. Depending on their location, they are divided into groups, for example, regional lymph nodes of the mammary gland or mediastinal (intrathoracic), ulnar, splenic, etc.

This group of regional accumulations of the mammary gland includes axillary, subclavian and parasternal lymph nodes.

Depending on the location, inflammation of one or another area of the accumulation of lymph nodes in the mammary gland will indicate the presence of problems in this area.

Axillary

Axillary lymph nodes are represented by their clusters along the vessels of the mammary gland in an amount from 15 to 45 pieces. They get their name from their location – the axillary region. It is located at the convergence of the limb, chest and back - the axillary region. They can be classified into several groups depending on their location - apical, central, lateral, thoracic and subscapular.

They perform the same functions as all other nodes - they cleanse the blood and protect the body from infections and viruses.

Possible problems and diseases

The main outflow of lymph occurs in the area under the armpit; the second largest outflow of lymphoid fluid is the supraclavicular and subclavian lymph nodes. Therefore, in the presence of inflammation of the mammary gland, the clusters of lymph nodes that are located in this area, namely the intramammary lymph node, react to it first.

The main causes of their inflammation are most often the following:

Mastitis. Women suffer from this problem mainly after the birth of a child and during breastfeeding. It can be caused by pathogenic microorganisms, staphylococcus, etc.
Mastopathy. It usually occurs during a period of hormonal changes in the body, or during a hormonal imbalance. At this time, the glandular component of the mammary gland is replaced. Such changes directly affect the lymphoid system.
Tumor-like neoplasm. Lymph nodes in the stage of inflammation are one of the most important symptoms of cancer. Negative consequences are immediately reflected in intramammary and axillary types of nodes. Their defeat by 60–70% indicates that the disease has reached such a stage that surgery cannot be avoided. Also, their increase may indicate the presence of metastases.
Tuberculosis of intrathoracic nodes. This is the most common form of primary tuberculosis. It is most often diagnosed in children and young people. Symptoms, in addition to inflammation of the nodes, are the following: weakness, pallor, body temperature of about 38 - 39 degrees, dry cough turning into wet, restlessness at night and sweating.
Tumor of the mediastinum. In lung cancer, the lymph nodes usually become inflamed on the side of the tumor. In the presence of such a disease, the lymph node may not be painful, but it must be dense. In addition, the following symptoms are identified: cough with sputum and pus, weakness, bluish skin of the face and neck, chest pain.
Infectious diseases.

Alarming symptoms

Lymphadenopathy or lymphadenitis is an inflammation of the lymph node of the mammary gland. Inflammation of the lymph nodes is not an independent disease in itself, but indicates a pathological process occurring in the immediate vicinity of them.

Inflammation of the lymph nodes on the sternum in women can be determined by the following signs:

increase in size;
pain on palpation;
change in symmetry in the arrangement of nodes;
on palpation the nodes are soft;
their mobility is observed;
swelling of the nipples and breasts;
redness of the skin.

In addition to changes in the clusters of lymph nodes, the presence of the disease is indicated, in aggregate, by the following signs:

increased body temperature;
increased sweating during sleep;
lowering blood pressure;
indigestion, which causes weight loss;
tachycardia;
enlarged liver and spleen.

Which doctor should I contact?

Most often, inflammation of the lymph nodes is diagnosed by a therapist or pediatrician in children. After consulting these doctors and passing the necessary tests, the doctor refers the patient to a more specialized specialist. If you suspect that inflammation of the thoracic lymph nodes is directly related to the mammary glands, this may be a mammologist or gynecologist.

Diagnostic methods

Symptoms of lymphadenopathy are usually helpful in diagnosing the disease. They can point out to the doctor areas of the body that need closer attention. It can be localized, that is, only one group of nodes becomes inflamed, or generalized—several groups increase at once or throughout the body.

Diagnosis begins with palpation of all accessible lymphatic systems. In this case, the following characteristics of nodes are assessed: density, size, body temperature, shape, etc. Then a general blood test is taken, most often a breast ultrasound, x-ray or mammography is prescribed. If necessary, a biopsy of lymph nodes in the chest is prescribed.

In approximately 1% of patients, a malignant tumor is detected upon diagnosis.

Video

You will learn about the reasons for enlarged lymph nodes in our video.

Lymph nodes are an integral part of the human immune system. Thanks to it, the body is protected from the harmful effects of various factors. Any change in the lymph nodes indicates that the body is fighting something bad. Often during examinations, women are given a conclusion about the presence of an intramammary node. So, intramammary lymph node - what is it? This is a lymph node from the axillary group, located in the glandular tissue. Its increase indicates the presence of inflammation or breast cancer. Therefore, it is important to detect this node at the very beginning of its formation.

Anatomy and functions of intramammary lymph nodes

Lymph nodes, ducts and vessels are part of the immune system. The lymph nodes in women's breasts are the first to respond to the inflammatory process and the penetration of foreign particles into the body. The lymph nodes of the breast belong to the axillary regional lymph nodes. They follow the course of the lymphatic vessels and are located in the fatty and glandular tissue of the breast. This is a group of lymph nodes on the chest. Normal intramammary lymph nodes:

located in the glandular tissue of the breast;
not palpable;
they are not visible to the naked eye;
painless;
normal body temperature;
the skin of the breast is not changed.

The function of the lymph nodes is to protect the body from infections. Its role is as follows:

removal of certain metabolic products from the body;
are responsible for the correctness of the body’s immune response;
responsible for the maturity of lymphocytes;
biological filter;
trap and neutralize cancer cells.

The lymph nodes of the mammary gland primarily collect lymph from the thoracic ducts and glandular tissues.

Important! You need to know what intramammary lymph nodes of the mammary glands are. Normally, they do not manifest themselves in any way and do not cause any complaints.

So, intramammary lymph nodes of the mammary gland, what are they? This is a lump in the upper outer quadrant of the chest. They can be either unilateral or bilateral. There are various reasons for the increase in this education, which we will consider below.

Causes of enlarged breast lymph nodes

Lymph nodes in the mammary gland can enlarge with or without the participation of an inflammatory process. If we are talking about the usual enlargement of lymph nodes in women in the chest, that is, lymphadenitis, its causes are:

cancer metastases;
imbalance of the hormonal system;
irregular sexual activity;
mammary gland injuries;
with fibroadenoma;
concomitant gynecological diseases;
induced or medical abortions;
disturbances in the functioning of the immune system.

Lymphadenitis is a condition known as inflammation of the thoracic lymph nodes. They can become inflamed due to:

diseases caused by infection - staphylococcus, streptococcus, protozoa;
the presence of foci of chronic infection in the body - chronic tonsillitis, tonsillitis, carious teeth;
presence of silicone implants in the breast;
diffuse purulent diseases of the anterior chest wall - phlegmon.

Bacteria play a fundamental role in the development of the purulent process in the lymph nodes. If you do not seek help in a timely manner, the inflammation progresses to the stage of abscess formation (accumulation of pus).

Diseases that cause inflammation of the chest lymph nodes

First of all, it is worth clarifying that the very fact of the appearance of this lymph node is not a disease. Indeed, often the causes of intramammary lymph node of the mammary gland are other diseases, such as:

mastitis - inflammation of tissue in the mammary glands;
mastopathy is a breast disease associated with hormonal imbalance;
metastases of cancerous tumors from other parts of the body.

Mastitis is a fairly common disease among women. The intramammary lymph node of the mammary gland most often enlarges precisely for this reason. More women suffer from this disease after pregnancy. During lactation, milk stagnates in the thoracic ducts. This creates ideal conditions for the proliferation of pathogenic microorganisms, and the nodes begin to become inflamed. If you do not follow the gynecologist's recommendations regarding breastfeeding, there is a high probability of suffering from mastitis.

Breast mastopathy, or fibroadenomatosis, is a benign growth of breast tissue associated with hormonal imbalance. Enlarged lymph nodes with mastopathy occur in women of childbearing age, from 18 to 45 years. This condition may be accompanied by inflammation of the lymph nodes of the chest. The main symptoms of mastopathy are:

periodic or constant breast tenderness, which intensifies at the beginning of the cycle;
white discharge from nipples;
the appearance of nodular compactions in the gland tissue.

Important! What to do to avoid mastopathy? It is necessary to express the milk remaining in the breast and treat concomitant diseases in a timely manner

Regional metastases most often enter the mammary gland through blood or lymph. They can also dissipate:

into the skin above the chest;
kidneys;
brain;
liver;
lungs.

Metastases are difficult to treat and can lead to death. Therefore, it is important to diagnose the process in a timely manner and begin treatment as early as possible.

Which doctor can help?

Mastitis is a common cause of enlarged thoracic lymph nodes (photo: www.gippokrat.com)

First of all, you need to contact your family doctor. He will conduct an examination and try to find out the cause of the enlarged lymph nodes in the mammary gland. The doctor will decide whether consultation with other specialists is necessary. Such consultants may be:

gynecologist;
oncologist;
surgeon.

The function of a gynecologist is to identify infections of the female reproductive system in the early stages. Also, during the examination, he may notice inflammation of the breast lymph node. This doctor treats various inflammations and hormonal disorders in the body.

An oncologist treats breast cancer, depending on the stage of the disease. In the first stages, minimal excision of the tumor is possible. Subsequently, a total mastectomy may be required. Very often, the hands swell after breast removal. Also includes treatment. After such an intervention, it is necessary to carry out a set of rehabilitation measures. Rehabilitation includes gymnastics and exercises. Recovery lasts from 3 to 5 months.

The surgeon treats mastitis, namely the purulent form. The operation is performed under general anesthesia. It includes the following steps:

Skin incision.
Opening and sanitation of the abscess.
Suturing and draining the wound.

Having cured the primary pathology, the enlarged lymph node gradually returns to its previous shape.

Necessary diagnostic methods

As a rule, diagnosing intramammary lymphadenitis is not difficult. Diagnostic methods include the following:

self-examination;
mammography;
ultrasonography;
chest x-ray;
CT scan;
thermography;
node biopsy.

An independent examination is carried out on the 10th day of the cycle in two positions - standing and lying down. It needs to be done every month. It is necessary to carefully examine the skin of both mammary glands and the nipple area. This manipulation must be carried out both with lowered and raised arms. Next, using circular movements, you need to slowly feel each quadrant of the chest on both sides. If there is compaction, pain or other sensations, consult a doctor immediately.

Important! It must be remembered that intramammary lymph nodes of the mammary gland are dangerous

Mammography and ultrasound are among the most informative diagnostic methods that can be used to see:

localization;
dimensions;
quantity;
adhesion to surrounding tissues;
the structure of the node that is inflamed.

A high degree of magnification allows you to see the most minor changes in the structure of the mammary gland.

A biopsy can confirm or refute the cancerous origin of the node. In turn, it also comes in different types:

fine-needle aspiration - a part of the glandular tissue is taken for cellular examination (cytological);
trucat biopsy - the material is studied at the tissue level;
ductography - study the ducts of the mammary gland.

Thermography is a method that can be used to see fabric prints on film. In healthy tissue, the temperature will be significantly lower than those that become inflamed.

Computed tomography provides an opportunity to see a complete picture of the pathological process. We can assess the size of the lesion and the presence of metastases. And also see diseases of other organs and systems.

Principles of treatment of thoracic lymphadenitis

To choose a treatment method for lymphadenitis, first of all, it is important to understand the cause of this condition. If the infectious origin of the inflammation is proven, the treatment regimen is as follows:

anti-inflammatory;
antibacterial.

Nonsteroidal anti-inflammatory drugs have a fairly wide spectrum of action, which includes:

anti-inflammatory effect;
antipyretic effect;
antiplatelet effect - thins the blood.

When taking this group of drugs, you need to remember about their side effects on different organs:

peptic ulcer of the stomach and duodenum;
toxic effect on the liver;
hematopoietic disorder;
allergic reactions, rash;
fluid retention in the body.

Antibacterial drugs also occupy a significant place in the treatment of lymphadenitis. Their mechanism of action is aimed at eliminating pathogenic microorganisms.

Side effects of taking antibacterial agents are:

allergic reactions to the components of the drug;
toxic effect on the kidneys and liver;
nausea, vomiting, constipation;
noise in ears;
dysbiosis.

Before taking antibiotics, it is necessary to determine their sensitivity to this group of drugs. This simple method helps improve the quality of treatment.

If we are talking about a cancer process, therapy is individually selected by the oncologist. It depends on the stage of cancer and includes:

chemotherapy;
radiation therapy;
surgical intervention.

As you can see, the treatment is quite difficult. It is much easier to prevent the development of lymphadenitis than to treat it. This is why you should do a breast self-examination every month. This simple action will help you avoid dire consequences and stay healthy.